Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care...

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Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative and the National Patient Centered Medical Home Movement November 2011

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Page 1: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Amy Gibson, MS, RNInterim Executive Director/Chief Operating Officer

Patient-Centered Primary Care Collaborative

Patient-Centered Primary Care Collaborative

and the National Patient Centered Medical Home Movement

November 2011

Page 2: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

History of the Medical Home Concept

The first known documentation of the term “medical home” Standards of Child Health Care, AAP in 1967 by the AAP Council on Pediatric Practice -- “medical home -- one central source of a child’s pediatric records” History of the Medical Home Concept Calvin Sia, Thomas F. Tonniges, Elizabeth Osterhus and Sharon Taba Pediatrics 2004;113;1473-1478

Patient Centered – IOM

I would strongly urge the adoption of the Danish model of the Patient Centered Medical Home -- Karen Davis, Commonwealth Fund

2010 Medical Home Wikipedia page: http://en.wikipedia.org/wiki/Medical_home

PCPCC Facebook Page

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http://en.wikipedia.org/wiki/Medical_home
Page 3: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

JOINT PRINCIPLES OF THE PCMH (FEBRUARY 2007)

The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

Principles:

Ongoing relationship with personal physician

Physician directed medical practice

Whole person orientation

Coordinated care across the health system

Quality and safety

Enhanced access to care

Payment recognizes the value added

3Source: PCPCC (www.pcpcc.net)

Page 4: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Overview of Activity

•Medical Home activity in every State

•44 States and the District of Columbia Have Passed over 330 Laws related to PCMH Activity

•Medicaid and Medicare Activity

•Over 14,800 practices recognized as PCMH

4Source: PCPCC Pilot Report (http://pcpcc.net/pilot-guide), October 2009

http://pcpcc.net/pilot-guide
Page 5: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Overview of PCMH Commercial Pilot Activity

Additionally, new projects are under development in the previous states, such as New York (Adirondack region), Florida (BCBS)

* As tracked by the American College of Physicians (updated March 2010)

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• Highmark Blue Cross Blue Shield

• Independence Blue Cross

• MVP Health Plan (New York)

• Oxford (New York)

• Priority Health• Silicon Valley

HIT

Page 6: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

There are 40 States Working to Advance Medical Homes for Medicaid or CHIP

Beneficiaries

AK

NH MA

ME

NJ

CTRI

DE

VT

NY

DCMD

NC

PA

WV

FL

GA

SC

KY

IN OH

MI

TN

MSAL

MO

IL

IA

MN

WI

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UT

CO

AZ

NM

IDOR

WA

NV

CA

States with at least one effort that met criteria for analysis

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Page 7: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

More Results…

PCPCC Pilot Guide

And on the PCPCC website…www.pcpcc.net

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Page 8: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

PCPCC Membership and Activity Overview

National Convener on the PMCH Legislative and Regulatory Advocacy Develop PCMH Policy

•More than 800 members

•70 Executive Committee Members

•16 Advisory Board Members

•6 Centers

•9 Task Forces

•2 Annual Conferences & Summits

•Monthly Calls (National PCMH Movement Briefings, CMD, CPPI, CCE, CEE, CeH, CAC)

•National Weekly Call (Thursday, 11AM ET)

712-432-0900Access Code: 868853

•Host Regular Webinars8

Page 9: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

The Patient-Centered Primary Care Collaborative

ACP

Providers 333,000

primary carePurchasers Most of the Fortune 500

Payers Patients

AAP AAFP AOA

ABIM AANP

ACOI AHI

IBM Ohio

General Electric

Merck

Dow

Pfizer

Business Coalitions

BCBSA United

Aetna

CIGNA

Humana

WellPoint

Kaiser Permanente

AARP AFL-CIO

National Consumers League

SEIU Foundation for Informed

Decision Making

Examples of Broad Stakeholder Support & Participation

The Patient-Centered Medical Home 80 Million lives

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Geisinger

Iowa

AMA

Source: PCPCC (www.pcpcc.net)

Page 10: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Patient Centered Primary Care Collaborative

Six ‘Centers’ - Over 770 volunteer membersCenter for Multi-Stakeholder Demonstration: Identify community-based pilot sites in order to test and evaluate the concept; offer hands-on technical assistance, share best practices, and identify funding sources to advance adoption.

Center to Promote Public Payer Implementation: Assist state Medicaid agencies and other public payers as they implement and refine programs to embed the Patient Centered Medical Home model by offering technical assistance; sharing best practices and giving guidance on the development of successful funding models.

Center for Employer Engagement: Create standards and buying criteria to serve as a guide and tool for large and small employers/purchasers in order to build the market demand for adoption of the Medical Home model.

Center for eHealth: Evaluate use and application of information technology to support and enable the development and broad adoption of information technology in private practice and among community practitioners.

Center for Consumer Engagement: Engage the consumer in awareness activities through three ways: day-to-day operations, messaging and pilots. The center will continue the use of “Patient Centered Medical Home”, but focus on how the concept and its components are communicated to the public and partner with large consumer groups to capitalize on their visibility and existing efforts.

The Center for Accountable Care this center will ensure that the patient centered medical home serves as the foundation for accountable care organizations, and that ACOs thrive as a result of strong robust PCMH support. 9

Source: PCPCC (www.pcpcc.net)

Page 11: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

PCPCC Board

Executive Committee &

Advisory Board

- 10 calls per year- 1 strategic planning meeting

Centers

Legislative Committee

Finance & Budget

Committee

Event Planning

CEE CPPI CMD CCE CeH

PCPCC General Membership

National Thursday

CallBriefing

Conferences- 2 annual Webinars

Ed and Training

MedicatiionMgmt

Mobile Health

Meaningful Use

-45 weekly calls

Payment Reform

Integrating Behavioral

Health

Care Coordination

PCPCC Organizational and Call Chart

CAC

Page 12: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

8Source: Health2 Resources 9.30.08

Defining the Medical Home

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Page 13: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

PCMH as Foundation for Accountable Care Organizations

13Source: Premier Healthcare Alliance

An ACO is defined as a group of providers that has the legal structure to receive and distribute incentive payments to participating providers.

Page 14: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

CURRENT STATE

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FEE FOR SERVICE

CARE MGMT FEE

(PMPM)

PAY FOR PERFORMANCE

(BONUS)

SHARED INCENTIVES FOR

MEDICAL NEIGHBORHOOD

$0 $0$0

Page 15: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

FUTURE STATE

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FEE FOR SERVICE

PAY FOR PERFORMANCE

(BONUS)

SHARED INCENTIVES FOR

MEDICAL NEIGHBORHOOD

PATIENT CENTERED MEDICAL HOME ---- ACCOUNTABLE CARE ORGANIZATION

CARE MGMT

FEE

(PMPM)

Page 16: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Physician Practice Size

(# of patients) Level 1+ Level 2+ Level 3+

< 10,000 $4.68 $5.34 $6.01

10,000 - 20,000 $3.90 $4.45 $5.01

> 20,000 $3.51 $4.01 $4.51

PMPM Payment: Commercial Population

Level of PCMH Recognition

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Tier Major Condition Groups Minutes of Work PMPM PMPM Payment

0 None N/ A N/ A

1 3-Jan 15 $10.14

2 6-Apr 30 $20.27

3 9-Jul 60 $40.54

4 10+ 90 $60.81

Page 17: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

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Payment Model Component PMPM Payment

Care management payments Up to $2.50 PMPM

Pay-for-performance payments Up to $2.50 PMPM

Payment Model Component PMPM Payment

Practice transformation cost payments (year 1 only)

$1.67 PMPM

Performance bonus (beginning in year 2) Up to $2.38 PMPM (value based on performance)

Risk-adjustment Up to $1.67 PMPM (only for practices with above average patient panel risk profiles; amount varies by practice)

Payment Model Component PMPM Payment

Practice support payments $1.50 PMPM

$0.60 PMPM (ages 0-17)

$1.50 PMPM (ages 18-64)

$5.00 PMPM (ages 65-74)

$7.00 PMPM (ages 75+)

Shared savings Value based on performance

Care management payments

Page 18: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Community Implications - Published Results of PCMH Projects to Date

Source: PCPCC Pilot Guide, 2010 18

Page 19: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Community Implications – Published Results of PCMH Projects (cont.)

Source: PCPCC Pilot Guide, 2010 19

Page 20: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Community Implications – Published Results of PCMH Projects (cont.)

Source: PCPCC Pilot Guide, 2010 20

Page 21: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Recognition Programs for PCMH Developed or Under Development

Quality Organizations PCMH Standards Activity

2010

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Page 22: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Federal PCMH Efforts

22Source: PCPCC (www.pcpcc.net)

Page 23: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

PCPCC Resources

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Value-Based Insurance Design

IT Guide Purchaser Guide

Consumer Guide

Source: PCPCC (www.pcpcc.net)

Medication Management Guide

Payment Reform Guide Participatory Engagement Guide

PCMH – Evidence of Quality

Practice Transformation Guide

Care Coordination Guide

Page 24: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

Test Drive the PCPCC Website !

Major features include Master calendar listing all

PCPCC events On-line and interactive Pilot

Guide User portals (consumer &

patients, employer & health plans, providers & clinicians, federal & state government

Center portals and updates

http://www.pcpcc.net

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Page 25: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

UPCOMING COLLABORATIVE EVENTS

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Spring Stakeholder Conference April 23-24, 2012

Washington Marriott Wardman Park - 2660 Woodley Road NW Washington, DC 20008

Reservations Number: 202-328-2000Cutoff Date: April 9, 2012

Page 26: Amy Gibson, MS, RN Interim Executive Director/Chief Operating Officer Patient-Centered Primary Care Collaborative Patient-Centered Primary Care Collaborative.

CONTACT INFORMATION

Visit our website – http://www.pcpcc.netTo request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact:

Amy Gibson, MS, RNPatient Centered Primary Care CollaborativeInterim Executive Director/Chief Operating Officer202.724.3332 202.679.9231 (cell)[email protected] Homer Building601 Thirteenth St., NW, Suite 400 NorthWashington, DC 20005

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